WHO recommendations on antenatal care for a positive pregnancy experience

Recommendations

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Task shifting components of antenatal care delivery ac Recruitment and retention of staff in rural and remote areas ae Antenatal care contact schedules E.5.1: Task shifting the promotion of health-related behaviours for maternal and newborn health ad to a broad range of cadres, including lay health workers, auxiliary nurses, nurses, midwives and doctors is recommended. E.5.2: Task shifting the distribution of recommended nutritional supplements and intermittent preventive treatment in pregnancy (IPTp) for malaria prevention to a broad range of cadres, including auxiliary nurses, nurses, midwives and doctors is recommended. E.6: Policy-makers should consider educational, regulatory, financial, and personal and professional support interventions to recruit and retain qualified health workers in rural and remote areas. E.7: Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care. Recommended Recommended Context-specific recommendation Recommended <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience ac. Recommendations adapted and integrated from the <strong>WHO</strong> guideline on Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting (OptimizeMNH) (2012). ad. Including promotion of the following: care-seeking behaviour and ANC utilization; birth preparedness and complication readiness; sleeping under insecticide-treated bednets; skilled care for childbirth; companionship in labour and childbirth; nutritional advice; nutritional supplements; other context-specific supplements and interventions; HIV testing during pregnancy; exclusive breastfeeding; postnatal care and family planning; immunization according to national guidelines. ae. Recommendation adapted and integrated from the <strong>WHO</strong> publication Increasing access to health workers in remote and rural areas through improved retention: global policy <strong>recommendations</strong> (2010). xvi
1. Introduction 1.1 Background International human rights law includes fundamental commitments of states to enable women and adolescent girls to survive pregnancy and childbirth as part of their enjoyment of sexual and reproductive health and rights and living a life of dignity (1). The World Health Organization (<strong>WHO</strong>) envisions a world where “every pregnant woman and newborn receives quality care throughout the pregnancy, childbirth and the postnatal period” (2). However, approximately 303 000 women and adolescent girls died as a result of pregnancy and childbirth-related complications in 2015 (3). Around 99% of maternal deaths occur in low-resource settings and most can be prevented (4). Similarly, approximately 2.6 million babies were stillborn in 2015, also mainly in low-resource settings (5). Nevertheless, there is evidence that effective interventions exist at reasonable cost for the prevention or treatment of virtually all life-threatening maternal complications (6), and almost two thirds of the global maternal and neonatal disease burden could be alleviated through optimal adaptation and uptake of existing research findings (7). But a human rights-based approach is not just about avoiding death and morbidity – it is about enabling health and well-being while respecting dignity and rights. Antenatal care (ANC) can be defined as the care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health conditions for both mother and baby during pregnancy. The components of ANC include: risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and health promotion. ANC reduces maternal and perinatal morbidity and mortality both directly, through detection and treatment of pregnancy-related complications, and indirectly, through the identification of women and girls at increased risk of developing complications during labour and delivery, thus ensuring referral to an appropriate level of care (8). In addition, as indirect causes of maternal morbidity and mortality, such as HIV and malaria infections, contribute to approximately 25% of maternal deaths and near-misses (9), ANC also provides an important opportunity to prevent and manage concurrent diseases through integrated service delivery (10). In low- and middle-income countries (LMICs), ANC utilization has increased since the introduction in 2002 of the <strong>WHO</strong> ANC model, known as focused ANC (FANC) or basic ANC, which is a goalorientated approach to delivering evidence-based interventions carried out at four critical times during pregnancy (11, 12). However, globally, during the period 2007–2014, only 64% of pregnant women attended the <strong>WHO</strong>-recommended minimum four contacts for ANC, suggesting that much more work needs to be done to address ANC utilization and quality. Currently, <strong>WHO</strong> guidance on routine ANC is fragmented, with related <strong>recommendations</strong> published across several different <strong>WHO</strong> guidelines and practical manuals. The 2002 FANC implementation manual, for example (12), does not contain relevant context-specific guidance, which needs to be sought elsewhere. In addition, evidence on the possible harm of the FANC model has recently become available, necessitating a review. This up-to-date, consolidated guideline for routine ANC has been produced by the <strong>WHO</strong> Department of Reproductive Health and Research (RHR), in collaboration with the Department of Nutrition for Health and Development (NHD) and the Department of Maternal, Newborn, Child and Adolescent Health (MCA), as part of <strong>WHO</strong>’s normative work on supporting evidence-informed policies and practices. By reviewing, updating and bringing together ANCrelated <strong>WHO</strong> <strong>recommendations</strong> regarding “what” should be offered and “how” it should be delivered in the form of this guideline, it is hoped that policymakers will more easily be able to adapt, adopt and implement these new ANC <strong>recommendations</strong>, presented in Chapter 3, which have also been configured to form the 2016 <strong>WHO</strong> ANC model, presented in Chapter 4. A scoping review was conducted to inform this guideline, and it revealed that what women want and Chapter 1. Introduction 1
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on screening, please refer to the 2
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are willing to be screened and test
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Values See “Women’s values” a
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Acceptability Qualitative evidence
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E.6: Recruitment and retention of s
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WHO headquarters (
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Dr Erika Ota Nutrition, evidence sy
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WHO recommendations on antenatal care for a positive pregnancy experience

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